From the Guidelines
Voltage Criteria for Left Ventricular Hypertrophy (LVH)
The voltage criteria for LVH, excluding Sokolow-Lyon, Dunn's, Estes', and Cornell's criteria, include indices based on products of voltage and QRS duration and computation of QRS area 1.
Details of the Criteria
- These criteria have been developed to improve the diagnosis of LVH, as the traditional criteria have limitations in terms of sensitivity and specificity.
- The product of voltage and QRS duration is a measure that takes into account both the amplitude of the QRS complex and its duration, providing a more comprehensive assessment of ventricular hypertrophy.
- The computation of QRS area is another approach that has been proposed, which involves calculating the area under the QRS complex to estimate the severity of hypertrophy.
- Additionally, composite use of several criteria and indices based on scores derived from regression equations that incorporate multiple electrocardiographic and nonelectrocardiographic factors have been developed to improve the accuracy of LVH diagnosis 1.
Clinical Application
- The choice of criteria depends on the specific patient population and the clinical context, as different criteria may have varying degrees of sensitivity and specificity in different groups.
- It is essential to specify which criteria are used in making a diagnosis and to apply multiple criteria in automated systems to improve the accuracy of LVH diagnosis 1.
- The evolution of new methods and technologies provides a compelling reason to reassess the role of the ECG in detecting cardiac hypertrophy and related abnormalities, and to update clinical practice based on new research findings and technological developments.
From the Research
Voltage Criteria for Left Ventricular Hypertrophy (LVH)
The voltage criteria for Left Ventricular Hypertrophy (LVH) except for Sokolow-Lyon, Dunn's, Estes', and Cornell's criteria include:
- Romhilt-Estes criteria 2
- Amplitude total and Amplitude total product criteria 3
- Peguero-Lo Presti Criteria 4
- Cornell and Sokolow-Lyon products 5
- QRS area criteria, including Cornell area and Sokolow area 5
Comparison of Voltage Criteria
The studies compared the performance of different voltage criteria in diagnosing LVH, including:
- Romhilt-Estes criteria vs. Cornell, modified Cornell, and Sokolow-Lyon criteria 2
- Amplitude total and Amplitude total product criteria vs. Cornell Voltage and Sokolow-Lyon criteria in patients with hypertrophic cardiomyopathy 3
- Peguero-Lo Presti Criteria vs. Cornell Voltage Criteria, Sokolow-Lyon Index, and Romhilt-Estes criteria 4
- Cornell and Sokolow-Lyon products vs. Cornell and Sokolow-Lyon voltage indexes 5
Diagnostic Accuracy
The diagnostic accuracy of the voltage criteria varied across studies, with:
- Romhilt-Estes criteria showing higher positivity of LVH diagnosis compared to voltage-based criteria 2
- Amplitude total and Amplitude total product criteria achieving maximal diagnostic accuracy in patients with hypertrophic cardiomyopathy 3
- Peguero-Lo Presti Criteria performing better than Cornell Voltage Criteria, Sokolow-Lyon Index, and Romhilt-Estes criteria in detecting LVH 4
- Cornell and Sokolow-Lyon products improving the detection of ECG-LVH in the hypertensive population 5